Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 3861  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (455 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
 :: Introduction
 ::  Materials and Me...
 ::  Introduction and...
 ::  Portable Monitor...
 ::  In-Laboratory Ve...
 ::  PM and CPAP Pres...
 ::  Portable Monitor...
 ::  Portable Monitor...
 ::  Adaptablity of A...
 :: Conclusion
 ::  References
 ::  Article Figures
 ::  Article Tables

 Article Access Statistics
    Viewed4141    
    Printed96    
    Emailed2    
    PDF Downloaded31    
    Comments [Add]    

Recommend this journal


 


 
  Table of Contents     
REVIEW
Year : 2015  |  Volume : 61  |  Issue : 4  |  Page : 223-229

Utility of portable monitoring in the diagnosis of obstructive sleep apnea


1 Department of Respiratory Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India
2 Megachips India, Bangalore, Karnataka, India

Date of Submission19-Mar-2015
Date of Decision20-Jun-2015
Date of Acceptance08-Aug-2015
Date of Web Publication5-Oct-2015

Correspondence Address:
A Aneja
Department of Respiratory Medicine, MS Ramaiah Medical College, Bangalore, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.166509

Rights and Permissions


 :: Abstract 

Obstructive sleep apnea (OSA) is a common but underdiagnosed sleep disorder, which is associated with systemic consequences such as hypertension, stroke, metabolic syndrome, and ischemic heart disease. Nocturnal laboratory-based polysomnography (PSG) is the gold standard test for diagnosis of OSA. PSG consists of a simultaneous recording of multiple physiologic parameters related to sleep and wakefulness including electroencephalography (EEG), electrooculography (EOG), surface electromyography (EMG), airflow measurement using thermistor and nasal pressure transducer, pulse oximetry and respiratory effort (thoracic and abdominal). Multiple alternative and simpler methods that record respiratory parameters alone for diagnosing OSA have been developed in the past two decades. These devices are called portable monitors (PMs) and enable performing sleep studies at a lower cost with shorter waiting times. It has been observed and reported that comprehensive sleep evaluation coupled with the use of PMs can fulfill the unmet need for diagnostic testing in various out-of-hospital settings in patients with suspected OSA. This article reviews the available medical literature on PMs in order to justify the utility of PMs in the diagnosis of OSA, especially in resource-poor, high-disease burden settings. The published practice parameters for the use of these devices have also been reviewed with respect to their relevance in the Indian setting.


Keywords: Obstructive sleep apnea (OSA), polysomnography (PSG), portable monitors (PMs), sleep


How to cite this article:
Krishnaswamy U, Aneja A, Kumar R M, Kumar T P. Utility of portable monitoring in the diagnosis of obstructive sleep apnea. J Postgrad Med 2015;61:223-9

How to cite this URL:
Krishnaswamy U, Aneja A, Kumar R M, Kumar T P. Utility of portable monitoring in the diagnosis of obstructive sleep apnea. J Postgrad Med [serial online] 2015 [cited 2019 May 19];61:223-9. Available from: http://www.jpgmonline.com/text.asp?2015/61/4/223/166509



 :: Introduction Top


Obstructive sleep apnea (OSA) is an important, yet inadequately diagnosed public health problem that is characterized by repetitive collapse of the upper airway during sleep. [1] It has been reported that OSA affects up to 5% of the world's population [2] with a prevalence of prevalence of 4% in males and 2% in females [3] aged between 30 years and 60 years of age. The available literature on the prevalence of this disorder in the Indian population is limited. A study performed by Sharma et al.[4] in an urban setting estimated the prevalence of OSA to be 13.7%.

OSA is a predisposing factor for multiple comorbidities such as hypertension, cardiovascular consequences (including sudden death), [5],[6] ischemic heart disease, stroke [7],[8],[9],[10],[11],[12] , and uncontrolled diabetes. An increased risk of road traffic accidents has also been reported in patients suffering from OSA. [13] The awareness about this disorder and its associated outcomes is on the rise among patients and clinicians. This has resulted in ever-increasing referrals to sleep clinics for diagnostic evaluation but the infrastructure to support the demand for rising sleep studies has not escalated commensurately. [14] The "gold standard" test for diagnosis of sleep disorders is a conventional, fully supervised, in-laboratory polysomnography (PSG). [15] With the limited availability of accredited sleep laboratories, certified sleep technologists, and complete polysomnography (CPSG) equipment in many countries, long waiting times and high costs of testing are inevitable. [14]

In view of the above mentioned reasons, several alternative diagnostic tools such as sleepiness questionnaires, clinical decision rules, [16] portable monitors (PMs), actigraphs, and peripheral arterial tone (PAT) monitors [16],[17] have been developed for the evaluation of OSA. Of these, portable monitors have been evaluated and accepted for selected patient groups in clinical guidelines in various countries. [18],[19]

This article reviews recent guidelines and published literature on the clinical use of portable monitoring devices to diagnose OSA and attempts to define the role of portable monitors, especially in high-disease burden, resource poor settings.


 :: Materials and Methods Top


A search of the available literature was done using the keywords "portable monitoring in obstructive sleep apnea" with filters over last 10 years in humans. The Medline search generated 125 results over the last 10 years. This included 2 systematic reviews and meta-analysis, 3 guideline statements, 16 review articles, 16 randomized controlled trials, and 24 validation studies. Sixty-four articles included expert opinions and cross-sectional studies. In addition, the search was supplemented with data from cross references cited in the bibliography of relevant articles.

The present review has been organized into the following sections:

  • Introduction and modes of portable monitoring.
  • PMs: Review of the literature.
  • Adaptability of available guidelines for PM in an Indian setting.



 :: Introduction and Modes of Portable Monitoring Top


Sleep testing devices were initially classified by the American Academy of Sleep Medicine into level 1 to level 4 devices based on the type of leads and setting of the device used [20] [Table 1]. Among these, portable monitoring devices were categorized as level 2, level 3, and level 4 sleep monitoring devices. These monitors have limited number of channels and are used for the diagnosis of certain sleep disorders such as OSA, insomnia, and restless legs syndrome. Recent technical advances have resulted in the design of a variety of compact PM devices that are battery-operated and easy to hook up (wearable). Many of these devices also have wireless monitoring capability. These devices are being proposed as feasible options for out-of-lab diagnosis of OSA. The various modes for portable sleep monitoring based on location, type of sleep study, and technician attendance have been depicted in [Table 2]. However, there are various models of such out of center (OOC) devices, incorporating different combinations of sensors for monitoring. Hence, a blanket acceptance or rejection of such devices has been a problem faced by sleep societies around the world. Recently, a system has been introduced categorizing these devices based on measurements of sleep, cardiovascular, oximetry, position, effort, and respiratory (SCOPER) parameters. [21] Using the SCOPER categorization, available PM devices with appropriate literature and validation studies have been categorized into a common scheme and devices are judged on whether they can produce a likelihood ratio (LR+) of at least 5 and a sensitivity of at least 0.825 at an in-laboratory apnea-hypopnea index (AHI) of 5. [21]
Table 1: AASM classification of sleep study equipment[20]

Click here to view
Table 2: Modes of portable sleep monitoring


Click here to view



 :: Portable Monitors: Review of Literature Top


PMs have been used as diagnostic tools for OSA for over two decades. [22] Several of these devices have been compared with the gold standard PSG in patients with suspected OSA. However, there is a paucity of data comparing the available PM devices with one other. Some of the PMs that have been validated against PSG include ApneaLink, [23] Edentec, [24],[25],[26] PolyG, [27] AutoSet, [28],[29],[30],[31],[32] Embletta, [33] Sibel home, [34] Bedbugg, [35] NovaSom, [36] WatchPAT, [37],[38],[39],[40] SNAP, [41] SOMNOcheck, [42] Stardust II, [43] Apnomonitor, [44] and Apnea Risk Evaluation System (ARES) [45] [Table 3]. The results of the studies conducted with some of these devices are discussed in detail below.
Table 3: Studies conducted for validation of various PM devices

Click here to view


Studies conducted to validate PM

Level 4 devices are the simplest forms of PMs and consist of a nasal cannula to monitor airflow and a finger probe to record oxygen saturation. Milton et al. evaluated the sensitivity and specificity of a Level 4 device, the ApneaLink™ [46] (ResMed Corporation) as a screening tool for sleep apnea. The AHI obtained using this device in the laboratory and at home was compared to attended sleep-laboratory PSG in fifty-nine patients with type 2 diabetes mellitus. The study demonstrated a high sensitivity and specificity (91% and 95%, respectively) of the at-home ApneaLink AHI with the simultaneous PSG at all AHI levels, the best results being at an AHI of ≥15 events/ h. The AHI comparison from the home and laboratory PM studies also demonstrated good sensitivity and specificity at AHI levels of ≥15 and ≥20 events/ h (sensitivity 76% and specificity 94% for both).

The same device was also compared with a level 1 device (Alice 4) for diagnostic accuracy by Ng et al.[47] in 50 patients with suspected OSA. They observed a close correlation (r = 0.978) between AHI obtained by the two devices at AHI >10/h as well as >20/h. Further, the correlation between PSG AHI and oxygen desaturation index by ApneaLink was strong (r = 0.895) thereby drawing the conclusion that the ApneaLink device was highly sensitive and specific in quantifying AHI for screening and diagnostic purposes when access to PSG was limited.

Another level 3 sleep monitor, Apnoeascreen II (hooked up by a technician) was compared with in-laboratory PSG by Quintana-Gallego et al.[48] in 75 patients with stable heart failure. Using AHI cutoff points of >5, >10, and >15, the authors generated diagnostic accuracies of 78.6%, 84%, and 80%, respectively. However, they reported an overall diagnostic failure rate of 8% in home studies.

While validation studies of several such monitors have been conducted, most studies comprised a small number of subjects. The details of studies performed with such devices are summarized in [Table 3].


 :: In-Laboratory Versus Home Sleep Studies Top


Home sleep studies have been evaluated with simultaneous in-laboratory PSG by many researchers. Iber et al.[48] compared in-laboratory and home monitoring in 76 participants using a level 2 device (Compumedics, Australia) using the Sleep Heart Health Study (SHHS) methodology. They reported that the median sleep time and sleep efficiency were better in home sleep studies. Further, median RDI values were comparable between at-home and in-laboratory measurements. They suggested that patients with an RDI <20 were more likely to be diagnosed in the laboratory when compared to those with RDI >20. The misclassification rate in home studies was 22% and was hypothesized as being due to night-to-night variability of OSA. Other studies [48],[49],[50],[51],[52] have also highlighted the night-to-night variability ranging from 10% to 20% in attended as well as unattended studies.

Dingli et al.[33] evaluated synchronous recording with PM and traditional in-laboratory PSG followed by a home sleep study with the Embletta device (Flaga, Iceland), a level 3 monitor. The home-based studies showed an overall good agreement with laboratory-based PSG outcomes (kappa coefficient: 0.54; P - 0.001). Apart from this, home screening resulted in 42% saving in diagnostic costs. Thus, home monitoring was suggested as a reliable and cost-effective method for screening in patients with suspected OSA.

The AASM guideline published in 2007 defines indications for unattended portable monitoring in specific patient populations with high suspicion of OSA. [53] According to the Indian Initiative on Obstructive Sleep Apnea (INOSA) guidelines, a laboratory-attended PSG is not necessary in all patients suspected to have OSA. Portable monitoring or out of center testing (OCST) with type 3 or type 4 devices (that should at least include airflow, oxygen saturation, and respiratory effort) is adequate for diagnosis. This is acceptable in conjunction with comprehensive sleep evaluation and in patients with high pretest probability of moderate to severe OSA without comorbid sleep disorders or medical disorders such as pulmonary disease, neuromuscular disease, or congestive heart failure. [18]

According to INOSA guidelines, comprehensive evaluation and assessment of pretest probability can be performed using questionnaires such as Epworth Sleepiness Scale (ESS), Berlin questionnaire, modified Berlin questionnaire and STOP-BANG questionnaire. Out of these, STOP-BANG is the most recommended screening tool before portable monitoring due to the ease of administration and high sensitivity.


 :: PM and CPAP Prescription Top


Although several comparative studies between PM and level 1 sleep studies have demonstrated a high sensitivity for PM, it is noteworthy that these studies predominantly concentrate on diagnostic accuracy and reliability. Translation of results derived from PM into continuous positive airway pressure (CPAP) prescription is an important consideration. This is especially important in settings where low cost home testing is a preferable alternative to in-laboratory PSG. Some prospective studies pertaining to this aspect of portable monitoring have been discussed below.

Rafael and coworkers [54] studied 55 patients wherein a therapeutic decision (use of CPAP) made with unattended PM device was compared with that made after a subsequent PSG. Patients were equally subdivided into the technician hookup (group 1) and self-hookup groups (group 2) at the time of initial PM monitoring. The authors reported that 16% of the recordings among the home study group were inconclusive. In 75% of the interpretable home studies, the diagnosis was seen to correlate with in laboratory PSG; this figure rose to 89% on exclusion of inconclusive home studies. Among the two subsets of home study, data were not interpretable due to artifacts in 7% of the patients in group 1 and 33% in group 2 (P < 0.05). CPAP decision disagreement between home and lab studies occurred in about one third of patients. Cost effectiveness analysis showed reduction in study costs at home compared to in lab study. Thus, this study projected home sleep studies with technician hook-up as a viable diagnostic modality to decide about CPAP prescription.

In a similar study, Parra et al.[55] tested 89 patients with suspected OSA in two settings, in the sleep laboratory using level 1 sleep study and at the patient's home using a portable monitor. In the latter setting, 50 patients were assisted by a technician and 39 patients set up the equipment themselves. An acceptable agreement was obtained between the AHI measured by full-PSG and PM. The clinical therapeutic decision taken after PM agreed with that taken with full-PSG in 89% of patients. Apart from this, the domiciliary studies were about three times less costly than level 1 PSG. They concluded that patients with suspected OSA should initially be studied in a home setting with a PM. Parra et al.[55] also noted that patients who were located far away from the hospital frequently preferred to be studied in the laboratory than at home. These findings were further validated by other studies. [56] However, in contrast there are two studies with a similar design that have found a higher frequency of unacceptable studies with PMs. [25],[57] The discrepancy with respect to error rates and acceptability of PMs among the various studies cited above can be explained in relation to the differences in technical specifications, data analyzed, sensors used in various PM devices, diverse patient groups and preferences, and study setting and availability of technicians for hookup at home.

Since continuous positive airway pressure can be titrated most effectively with monitoring in a sleep laboratory, [58] an attended in-laboratory CPAP titration study/split night study was also necessary conventionally after a diagnosis of OSA was made. However, nowadays the validation and clinical use of the auto-titrating PAP device minimizes the need for an in-laboratory titration study for patients with moderate to severe OSA. This is feasible since these devices can be used in an unattended way to determine fixed CPAP treatment pressure for such patients who do not have significant co morbidities such as congestive cardiac failure, chronic obstructive pulmonary disease, central sleep apnea syndrome, and hypoventilation syndrome. [59]

Further, in patients with more than one sleep disorder such as OSA and insomnia, in patients with problems such as overlap syndrome (where suboptimal levels of CPAP can actually worsen hypoxia) as well as patients underdiagnosed by PM, home studies may be followed by repeat type I test. Apart from this, knowledge of autotitrating CPAP devices may not be uniform, especially with respect to known contraindications in certain special populations (heart failure), limitations (nasal obstruction), and variability in device performance, and air leak between manufacturers. [60]


 :: Portable Monitoring: The Indian Scenario Top


As opposed to the global data described above, awareness about sleep disorders and scientific research in sleep medicine in the Indian subcontinent has demonstrated a gradual upward trend only since the past two decades. The paucity of trained sleep technologists and physicians, financial considerations, and an unknown disease burden has led to a widespread use of PMs in both clinical and research settings. In a study by Udwadia et al., [61] the prevalence of OSA was estimated using technician hookup-based PM (Compumedics P series). OSA prevalence in middle-aged urban Indian men was estimated to be 19.5%.


 :: Portable Monitors: Summary of Available Literature Top


It is evident from the literature reviewed in the preceding paragraphs that there is considerable heterogeneity in the applicability and modes of portable monitoring for the diagnosis of OSA.

However, there is compelling evidence to suggest that home sleep studies have evolved as a viable and more economical mode of diagnosing OSA worldwide. When equipment with multiple channels are used, the involvement of a sleep technician for hookup in the patient's home has been shown to be a good intervention to improve the accuracy and reliability of testing. The inferred merits and demerits of PM are summarized in [Table 4].
Table 4: Merits and demerits of portable sleep monitoring

Click here to view



 :: Adaptablity of Available Guidelines for PM in Indian Setting Top


Practice parameters for PSG were first published by the American Sleep Disorders Association in 1994. [20] On the basis of the then available literature on PM, these guidelines considered that PM had inadequate sensitivity for routine diagnostic testing. Subsequent to these guidelines, several systematic reviews and meta-analyses regarding the use of portable devices were published.

In 2007, the American Academy of Sleep Medicine (AASM) updated practice parameters for the use of unattended PMs in the diagnosis of OSA in adult patients and since its publication, further studies have already been conducted adding to the pool of evidence. The major recommendations in this statement are hereby reviewed in the context of their adaptability in the Indian setting [Table 5]. Recently published Indian guidelines (INOSA) accept PM (type 3 and 4) as a useful, cost-effective, convenient, and speedy method of diagnosis after careful patient selection and by a trained sleep physician.
Table 5: Summary of major recommendations by AASM with adaptability in India

Click here to view


A flowchart to guide selection of patients for portable sleep studies is depicted in [Figure 1].
Figure 1: Flowchart to guide PM selection

Click here to view



 :: Conclusion Top


A detailed evaluation for pretest probability (risk stratification, screening with sleepiness scales, and clinical exam, especially upper airway evaluation) in conjunction with portable monitoring has been recommended to obviate the need for level 1 and level 2 sleep studies in patients with OSA. This holds special importance, especially in resource poor settings. The published practice parameters for PM are relevant and applicable in the Indian setting. In conclusion, a greater adoption of PMs by trained sleep physicians would enable the timely diagnosis of OSA with reduced cost and waiting time.

Financial support and sponsorship

This is to state that none of the authors have received any form of sponsorship, support, or funding in the compilation and drafting of this review article.

Conflicts of interest

There are no conflicts of interest.

 
 :: References Top

1.
Lam JC, Sharma SK, Lam B. Obstructive sleep apnoea: Definitions, epidemiology and natural history. Indian J Med Res 2010;131:165-70.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: A population health perspective. Am J Respir Crit Care Med 2002;165:1217-39.  Back to cited text no. 2
    
3.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.  Back to cited text no. 3
    
4.
Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest 2006;130:149-56.  Back to cited text no. 4
    
5.
Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med 2005;352:1206-14.  Back to cited text no. 5
    
6.
Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: An observational study. Lancet 2005;365:1046-53.  Back to cited text no. 6
    
7.
Wessendorf TE, Teschler H, Wang YM, Konietzko N, Thilmann AF. Sleep-disordered breathing among patients with first-ever stroke. J Neurol 2000;247:41-7.  Back to cited text no. 7
    
8.
Turkington PM, Bamford J, Wanklyn P, Elliott MW. Prevalence and predictors of upper airway obstruction in the first 24 hours after acute stroke. Stroke 2002;33:2037-42.  Back to cited text no. 8
    
9.
Harbison J, Ford GA, James OF, Gibson GJ. Sleep-disordered breathing following acute stroke. QJM 2002;95:741-7.   Back to cited text no. 9
    
10.
Iranzo A, Santamaria J, Berenguer J, Sánchez M, Chamorro A. Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction. Neurology 2002;58:911-6.  Back to cited text no. 10
    
11.
Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB. Investigating the relationship between stroke and obstructive sleep apnea. Stroke 1996;27:401-7.  Back to cited text no. 11
    
12.
Bassetti C, Aldrich MS. Sleep apnea in acute cerebrovascular diseases: Final report on 128 patients. Sleep 1999;22:217-23.  Back to cited text no. 12
    
13.
Masa JF, Rubio M, Findley LJ. Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. Am J Respir Crit Care Med 2000;162:1407-12.  Back to cited text no. 13
    
14.
Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med 2004;169:668-72.  Back to cited text no. 14
    
15.
Gay PC, Selecky PA. Are sleep studies appropriately done in the home? Respir Care 2010;55:66-75.  Back to cited text no. 15
    
16.
Tsai WH, Remmers JE, Brant R, Flemons WW, Davies J, Macarthur C. A decision rule for diagnostic testing in obstructive sleep apnea. Am J Respir Crit Care Med 2003;167:1427-32.  Back to cited text no. 16
    
17.
Gurubhagavatula I, Maislin G, Pack AI. An algorithm to stratify sleep apnea risk in a sleep disorders clinic population. Am J Respir Crit Care Med 2001;164:1904-9.  Back to cited text no. 17
    
18.
Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, et al.; Apnoea INOSA Guidelines Working Group; Indian Initiative on Obstructive Sleep. Consensus & evidence-based INOSA Guidelines 2014 (first edition). Indian J Med Res 2014;140:451-68.  Back to cited text no. 18
[PUBMED]  Medknow Journal  
19.
Canadian Agency for Drugs and Technologies in Health (CADTH). Portable monitoring devices for diagnosis of obstructive sleep apnea at home: Review of Accuracy, cost-effectiveness, guidelines, and coverage in Canada. CADTH Technol Overv 2010;1:e0123.  Back to cited text no. 19
    
20.
Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association. Sleep 1994;17:372-7.  Back to cited text no. 20
[PUBMED]    
21.
Collop NA, Tracy SL, Kapur V, Mehra R, Kuhlmann D, Fleishman SA, et al. Obstructive sleep apnea devices for out-of-center (OOC) testing: Technology evaluation. J Clin Sleep Med 2011;7:531-48.  Back to cited text no. 21
    
22.
Ahmed M, Patel NP, Rosen I. Portable Monitors in the diagnosis of obstructive sleep apnea. Chest 2007;132:1672-7.  Back to cited text no. 22
    
23.
Chen H, Lowe AA, Bai Y, Hamilton P, Fleetham JA, Almeida FR. Evaluation of a portable recording device (ApneaLink) for case selection of obstructive sleep apnea. Sleep Breath 2009;13:213-9.  Back to cited text no. 23
    
24.
Redline S, Tosteson T, Boucher MA, Millman RP. Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device. Chest 1991;100:1281-6.   Back to cited text no. 24
    
25.
Whittle AT, Finch SP, Mortimore IL, MacKay TW, Douglas NJ. Use of home sleep studies for diagnosis of the sleep apnoea/hypopnoea syndrome. Thorax 1997;52:1068-73.   Back to cited text no. 25
    
26.
Jiménez Gómez A, Golpe Gómez R, Carpizo Alfayate R, de la Roza Fernández C, Fernández Rozas S, García Pérez MM. The validation of a portable 3-channel recording system (Oxyflow, Edentec) for the diagnosis of the sleep apnea syndrome. Arch Bronconeumol 2000;36:7-12.   Back to cited text no. 26
    
27.
Man GC, Kang BV. Validation of a portable sleep apnea monitoring device. Chest 1995;108:388-93.  Back to cited text no. 27
    
28.
Bradley PA, Mortimore IL, Douglas NJ. Comparison of polysomnography with ResCare Autoset in the diagnosis of the sleep apnoea/hypopnoea syndrome. Thorax 1995;50:1201-3.   Back to cited text no. 28
    
29.
Fleury B, Rakotonanahary D, Hausser-Hauw C, Lebeau B, Guilleminault C. A laboratory validation study of the diagnostic mode of the Autoset system for sleep-related respiratory disorders. Sleep 1996;19:502-5.  Back to cited text no. 29
    
30.
Kiely JL, Delahunty C, Matthews S, McNicholas WT. Comparison of a limited computerized diagnostic system (ResCare Autoset) with polysomnography in the diagnosis of obstructive sleep apnoea syndrome. Eur Respir J 1996;9:2360-4.   Back to cited text no. 30
    
31.
Gugger M. Comparison of ResMed AutoSet (version 3.03) with polysomnography in the diagnosis of the sleep apnoea/hypopnoea syndrome. Eur Respir J 1997;10:587-91.  Back to cited text no. 31
    
32.
Mayer P, Meurice JC, Philip-Joet F, Cornette A, Rakotonanahary D, Meslier N, et al. Simultaneous laboratory-based comparison of ResMed Autoset with polysomnography in the diagnosis of sleep apnoea/hypopnoea syndrome. Eur Respir J 1998;12:770-5.  Back to cited text no. 32
    
33.
Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW, et al. Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 2003;21:253-9.  Back to cited text no. 33
    
34.
Ballester E, Solans M, Vila X, Hernandez L, Quintó L, Bolivar I, et al. Evaluation of a portable respiratory recording device for detecting apnoeas and hypopnoeas in subjects from a general population. Eur Respir J 2000;16:123-7.   Back to cited text no. 34
    
35.
Claman D, Murr A, Trotter K. Clinical validation of the Bedbugg in detection of obstructive sleep apnea. Otolaryngol Head Neck Surg 2001;125:227-30.   Back to cited text no. 35
    
36.
Reichert JA, Bloch DA, Cundiff E, Votteri BA. Comparison of the NovaSom QSG, a new sleep apnea home-diagnostic system, and polysomnography. Sleep Med 2003;4:213-8.  Back to cited text no. 36
    
37.
Bar A, Pillar G, Dvir I, Sheffy J, Schnall RP, Lavie P. Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies. Chest 2003;123:695-703.  Back to cited text no. 37
    
38.
Pittman SD, Ayas NT, MacDonald MM, Malhotra A, Fogel RB, White DP. Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: In-laboratory and ambulatory validation. Sleep 2004;27:923-33.   Back to cited text no. 38
    
39.
Ayas NT, Pittman S, MacDonald M, White DP. Assessment of a wrist-worn device in the detection of obstructive sleep apnea. Sleep Med 2003;4:435-42.  Back to cited text no. 39
    
40.
Zou D, Grote L, Peker Y, Lindblad U, Hedner J. Validation a portable monitoring device for sleep apnea diagnosis in a population based cohort using synchronized home polysomnography. Sleep 2006;29:367-74.   Back to cited text no. 40
    
41.
Su S, Baroody FM, Kohrman M, Suskind D. A comparison of polysomnography and a portable home sleep study in the diagnosis of obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 2004;131:844-50.   Back to cited text no. 41
    
42.
Tonelli de Oliveira AC, Martinez D, Vasconcelos LF, Gonçalves SC, Lenz MC, Fuchs SC, et al. Diagnosis of obstructive sleep apnea syndrome and its outcomes with home portable monitoring. Chest 2009;135:330-6.  Back to cited text no. 42
    
43.
Santos-Silva R, Sartori DE, Truksinas V, Truksinas E, Alonso FF, Tufik S, et al. Validation of a portable monitoring system for the diagnosis of obstructive sleep apnea syndrome. Sleep 2009;32:629-36.   Back to cited text no. 43
    
44.
Yagi H, Nakata S, Tsuge H, Yasuma F, Noda A, Morinaga M, et al. Significance of a screening device (Apnomonitor 5) for sleep apnea syndrome. Auris Nasus Larynx 2009;36:176-80.   Back to cited text no. 44
    
45.
Westbrook PR, Levendowski DJ, Cvetinovic M, Zavora T, Velimirovic V, Henninger D, et al. Description and validation of the apnea risk evaluation system: A novel method to diagnose sleep apnea-hypopnea in the home. Chest 2005;128:2166-75.  Back to cited text no. 45
    
46.
Erman MK, Stewart D, Einhorn D, Gordon N, Casal E. Validation of the ApneaLink for the screening of sleep apnea: A novel and simple single-channel recording device. J Clin Sleep Med 2007;14:387-92.  Back to cited text no. 46
    
47.
Ng SS, Chan TO, To KW, Ngai J, Tung A, Ko FW, et al. Validation of a portable recording device (ApneaLink) for identifying patients with suspected obstructive sleep apnoea syndrome. Intern Med J 2009;39:757-62.  Back to cited text no. 47
    
48.
Iber C, Redline S, Kaplan Gilpin AM, Quan SF, Zhang L, Gottlieb DJ, et al. Polysomnography performed in the unattended home versus the attended laboratory setting--Sleep Heart Health Study methodology. Sleep 2004;27:536-40.  Back to cited text no. 48
    
49.
Stepnowsky CJ Jr, Orr WC, Davidson TM. Nightly variability of sleep-disordered breathing measured over 3 nights. Otolaryngol Head Neck Surg 2004;131:837-43.  Back to cited text no. 49
    
50.
Quan SF, O'Connor GT, Quan JS, Redline S, Resnick HE, Shahar E, et al. Association of physical activity with sleep-disordered breathing. Sleep Breath 2007;11:149-57.  Back to cited text no. 50
    
51.
Meyer TJ, Eveloff SE, Kline LR, Millman RP. One negative polysomnogram does not exclude obstructive sleep apnea. Chest 1993;103:756-60.  Back to cited text no. 51
    
52.
Wittig RM, Romaker A, Zorick FJ, Roehrs TA, Conway WA, Roth T. Night-to-night consistency of apneas during sleep. Am Rev Respir Dis 1984;129:244-6.  Back to cited text no. 52
[PUBMED]    
53.
Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al.; Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007;3:737-47.  Back to cited text no. 53
    
54.
Golpe R, Jiménez A, Carpizo R. Home sleep studies in the assessment of sleep apnea/hypopnea syndrome. Chest 2002;122:1156-61.  Back to cited text no. 54
    
55.
Parra O, García-Esclasans N, Montserrat JM, García Eroles L, Ruíz J, López JA, et al. Should patients with sleep apnoea/hypopnoea syndrome be diagnosed and managed on the basis of home sleep studies? Eur Respir J 1997;10:1720-4.  Back to cited text no. 55
    
56.
Parthasarathy S, Haynes PL, Budhiraja R, Habib MP, Quan SF. A national survey of the effect of sleep medicine specialists and American Academy of Sleep Medicine Accreditation on management of obstructive sleep apnea. J Clin Sleep Med 2006;2:133-42.  Back to cited text no. 56
    
57.
Portier F, Portmann A, Czernichow P, Vascaut L, Devin E, Benhamou D, et al. Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome. Am J Respir Crit Care Med 2000;162:814-8.  Back to cited text no. 57
    
58.
Skjodt NM. Approach to outpatient management of adult sleep apnea. Can Fam Physician 2008;54:1408-12.  Back to cited text no. 58
    
59.
Kirsch DB. PRO: Sliding into home: Portable sleep testing is effective for diagnosis of obstructive sleep apnea. J Clin Sleep Med 2013;9:5-7.  Back to cited text no. 59
    
60.
Parthasarathy S. CON: Thoughtful steps informed by more comparative effectiveness research is needed in home testing. J Clin Sleep Med 2013;9:9-12.  Back to cited text no. 60
    
61.
Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. Am J Respir Crit Care Med 2004;169:168-73.  Back to cited text no. 61
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
Print this article  Email this article
 
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow